Criminal Case Cover Sheet

Criminal Case Cover Sheet U.S. District Court - Northern District of New York Please complete one Cover Sheet for each named defenda nt - Citation and Count Information is to be recorded on Page 2. Cover sheets are to be submitted to the Clerk at the time of filing - See Local Rule of Criminal Procedure 57.1 Complaint Information Indictment Superseding Place of Offense: County: Related Case Information: Magistrate Judge Case Number S earch Warrant Case Number (Misc. Number) Rule 20/Rule 40 from District of Superseding In dictment Docket Number Same Defendant New Defendant Is the Related Case Sealed? YES NO (If related case is no longer sealed provide unsealing order) Defendant Information: Juvenile - YES - NO If YES, L - Please Include A Sealing Order (18 U.S.C. 5038) Defendant Name Alias Name Address Birth date: SSN: Sex: Race: Nationality US Interpreter: YES - NO If YES, L List Language and/or Dialect: Location Status: Arrest Date [ ] Already in Federal Custody as of in [ ] Already in State Custody [ ] On Pretrial Release Is the Accusatory Instrument to be Sealed? YES - NO If YES, L Provide Sealing Order U. S. Attorney Information: Assistant United States Attorney Bar # Dated: Office: SYRACUSE <<<<<<<<<********>>>>>>>>>>>>> 2CRIMINAL CASE COVER SHEET MATTER CITATION & COUNT FORM US DISTRICT COURT - NDNY Instructions: a) List Title & Section (Index/Key Code) for each count Please list only one (1) count on each line. b) Include a short description of the Title & Section. c) List all named defendants associated with each count. USA vs. Case No. * List all defendants associated with this count. Title & Description of Offense Count Defendant(s)* Section Citation Count Form Page 1 of 1